1. Traumatic neurosis is covered under the Workers Compensation Act if it results from a
covered physical injury and meets the other requirements of the Act.

2. Traumatic neurosis caused by an emotional, nonphysical trauma on the job is not covered
in Kansas by the Workers Compensation Act.

3. Under the Workers Compensation Act, traumatic neurosis is to be treated like any other
health problem. If a subsequent covered industrial accident aggravates, accelerates, or
intensifies the disease or affliction, the worker is not to be denied compensation just
because it is a preexisting condition.

Boutwell had a history of schizoaffective disorder. From 1979 to 1989, he held a
variety of jobs, including salvage yard worker, hospital orderly, backhoe operator, and
carpenter. Boutwell saw Dr. J. Luis Ibarra beginning in 1979 for his mental disorders.
Dr. Ibarra treated him with psychotherapy and psychotropic medications. Boutwell had
severe ongoing psychiatric problems, resulting in an involuntary commitment and other
hospitalizations. Following Dr. Ibarra's retirement, Boutwell was treated by Dr. Poly
Tan.

Boutwell began working for Domino's Pizza in March 1989. While delivering a
pizza to an apartment complex, he was attacked in an attempted robbery and received
nine knife stab wounds. The attack resulted in injuries to his knees, the loss of a
kidney, and the removal of part of his colon.

On October 13, 1989, Boutwell applied for workers compensation. He
subsequently impled the Workers Compensation Fund (Fund). The Fund then brought
a civil action against Domino's seeking reimbursement, and that action was eventually
settled. In 1996, the administrative law judge (ALJ) entered an award finding the attack
had aggravated Boutwell's mental condition, resulting in permanent and total disability.
The Workers Compensation Board (Board) adopted the ALJ's findings and conclusions
and affirmed the award. The Fund timely appeals.

The Board found Boutwell suffered post-traumatic stress disorder and was
therefore eligible for compensation. The Fund argues on appeal that the evidence does
not support this conclusion, either as a matter of fact or as a matter of law.

This court will uphold the Board's finding if it is supported by substantial
competent evidence, which is evidence possessing something of substance and
relevant consequence and carrying fitness to induce conviction that the award is
proper, or furnishing substantial basis of fact from which the issue can be reasonably
resolved. Depew v. NCR Engineering & Manufacturing, 263 Kan. 15, 26, 947
P.2d 1
(1997).

The evidence in the record amply supports the Board's factual conclusions.
Following the attack, Boutwell complained of inability to sleep. He reported he
experienced greater anxiety about being among people and experienced greater anger.
He reported increased depression and spontaneous crying. He stated he was no
longer able to compete, tolerate other people, or concentrate on a job with sufficient
ability to hold regular employment.

Dr. Ibarra, now retired, was a licensed psychiatrist with extensive experience in
psychiatric practice. Although Dr. Ibarra is not board-certified in psychiatry, he was a
licensed practicing psychiatrist and had been qualified as an expert in several trials. He
met with Boutwell a number of times both before and after the attack. Dr. Ibarra
testified Boutwell's mental state began to deteriorate after the attack. He began to
manifest anger in ways he had not done before. Dr. Ibarra attributed the mental
deterioration to the distress resulting from the assault.

Dr. Ibarra noted that Boutwell had difficulty discussing the assault and appeared
to be in denial about its effects on him. He testified the anxiety resulting from the
assault precluded Boutwell from employment. Dr. Ibarra testified that while Boutwell
had been marginally employable before the attack, he no longer had the ability to work.
Dr. Ibarra increased Boutwell's diagnosed disability from at least 50% to 100% based
on his ongoing observations. Dr. Ibarra testified Boutwell suffered from post-traumatic
stress disorder. Dr. Tan also provided evidence of psychological disability.

The Fund offered witnesses who testified by deposition that Boutwell suffered no
lasting psychological effects from the attack. Dr. Neil Roach testified Boutwell had
become emotionally stronger as a result of the attack. He claimed Boutwell had a
"greater sense of omnipotence" as a result of the attack and was better able to resolve
his anger. Although Dr. Roach saw signs of delusional and disorganized thinking, he
observed little negative impact from the stabbing. In fact, Dr. Roach concluded that
Boutwell was more stable and psychologically better off after the stabbing. He saw no
evidence of post-traumatic stress disorder. Dr. Roach's analysis was based on written
tests and one consultation with Boutwell.

Dr. George Dyck testified that testing showed the attack had exacerbated
Boutwell's withdrawal and suspiciousness but did not cause the onset of the
symptomatology. He found no evidence of post-traumatic stress disorder. Dr. Dyck
believed Boutwell would have had a marginal ability to maintain employment even
without the attack. He expressly disagreed with Dr. Ibarra's conclusions and his basis
for those conclusions.

The appellate court cannot pass on the credibility of witnesses or weigh
conflicting evidence. City of Wichita v. Rice, 20 Kan. App. 2d 370, 373, 889 P.2d
789
(1995). It is the function of the administrative hearing body to determine the weight or
credibility of the testimony of witnesses. See Swezey v. State Department of Social &
Rehabilitation Services, 1 Kan. App. 2d 94, 98, 562 P.2d 117 (1977). Although the ALJ
could have elected to believe Dr. Dyck or Dr. Roach, he accepted the testimony of the
two treating physicians, Dr. Ibarra and Dr. Tan. Given the severity of the attack and the
preexisting condition, this decision appears reasonable. With our standard of review, it
is very difficult to see how the Fund could possibly expect a reversal on this ground.

The Board also found the attack aggravated Boutwell's preexisting
schizophrenia. The Fund argues that the evidence does not support this conclusion
and, taking a position of greater persuasiveness, that the law does not permit
compensation for aggravation of a preexisting psychiatric condition.

Again, this court will not reweigh the evidence. The Board's conclusion that the
attack aggravated Boutwell's psychological problems appears reasonable and is
supported by substantial credible evidence with which we will not burden the record by
repeating.

Of far greater difficulty is the question of whether an aggravation of a mental
condition is compensable under our Workers Compensation Act.

The history of this issue in the appellate courts of Kansas is long and somewhat
puzzling.

Hayes v. Garvey Drilling Co., 188 Kan. 179, 360 P.2d 889 (1961), initially
involved an injury which occurred when Hayes stepped backwards onto some pump
belts and was thrown to the ground, causing serious injuries to his left leg, back, and
chest, as well as other injuries.

Sometime after the commissioner made an unappealed finding that Hayes had
suffered a 25.4% permanent partial general disability, Hayes filed an application for
review and modification in which he alleged he was totally disabled due to psychiatric
problems. He prayed for an order increasing the original award to one of total disability.

Following a hearing on the request, the commissioner found "'that the anxiety
tension state for which review and modification is sought, pre-dated the accidental
injury suffered by claimant June 6, 1957, and that the application to review and modify
the existing award should be denied.'" 188 Kan. at 180.

The district court reversed on appeal, saying:

"'(4) That after considering the case as a whole and reading the transcripts, briefs of
counsel, and
hearing arguments of counsel, I am of the opinion that the claimant is one hundred per cent
(100%) totally
and permanently disabled as a result of traumatic neurosis and that such condition was directly
caused
and is a result of the accident and injuries the claimant sustained on the 6th day of June, 1957.
The fact
that the claimant had a predisposition to a neurosis in that he was a potential psycho-neurotic at
the time
of the accident is immaterial since the accident was the exciting cause which precipitated the
nervous
symptoms.'" 188 Kan. at 181.

The Supreme Court noted:

"At the hearing on the application for review and modification it was brought out that
while in
military service in World War II the claimant had been hospitalized on at least three occasions
for
'emotional and nervous disorders.' Certain records of the Veterans Administration were
introduced by the
testimony of a Dr. Bernstorf, by deposition and they definitely established that claimant had
suffered
emotional strain for a number of years." 188 Kan. at 182.

Finally, the Supreme Court said:

"The above-quoted portions of the medical testimony speak for themselves. While
claimant's
physical injuries were principally to his leg, back and chest--the end result was that his mental
condition
became such as to render him totally disabled--all of which was directly traceable to his
accidental injury.
Traumatic neurosis, following physical injury, long has been recognized as being compensable
under
workmen's compensation laws, and the rule is applicable to such injury even though financial
and other
worries play a part. (Morris v. Garden City Co., 144 Kan. 790, 792, 62 P.2d 920
[(1936)]; Barr v. Builders,
Inc., 179 Kan. 617, [Syl. ¶]4, 296 P.2d 1106 [(1956)].) Furthermore, it is
well-settled that the workmen's
compensation act prescribes no standard of health for workmen, and where a workman is not in
sound
health but is accepted for employment and a subsequent industrial accident suffered by him
aggravates or
accelerates an existing disease, or intensifies the affliction, he is not to be denied compensation
merely
because of such pre-existing condition. (Strasser v. Jones, 186 Kan. 507, 511, 350
P.2d 779 [1960])"
188 Kan. at 184.

From these statements it appears that Hayes clearly stands for the proposition
that a preexisting mental condition which is aggravated by a work-related physical injury
is compensable under the Workers Compensation Act if it has an impact on the
ability
to work.

In Jacobs v. Goodyear Tire & Rubber Co., 196 Kan. 613, 412 P.2d 986
(1966),
the court was presented with an employee who was caught between the alleged
conflicting demands of his employer, who wanted a maximum number of tires built, and
fellow employees, who wanted the production standard to be lower than that desired by
management. Jacobs claimed the psychological stress this caused him led to a
compensable psychiatric illness. There was no physical injury involved.

The Jacobs court stated:

"[I]t appears that claimant's difficulty resulted from conflicts created by the opposing
demands of
management and union co-employees rather than the nature and requirements of his job. Such
testimony
would support the conclusion that there was no causal connection between the work being
performed and
claimant's condition. Moreover, the demands of the co-employees were an external force over
which
management had no control or responsibility, and without them, it is speculative whether or not
claimant
would have encountered any difficulty." 196 Kan. at 617.

In Berger v. Hahner, Foreman & Cale, Inc., 211 Kan. 541, 506 P.2d
1175 (1973),
Marvin Berger, while on a construction site, was struck in the right eye by a 2 x 4 board
which eventually caused him to lose useful vision in that eye. Psychiatrists testified that
crippling psychiatric problems had been generated by Berger's reaction to this injury
and its impact, along with other preexisting conditions, on his ability to work.

The ALJ and the trial court denied compensation for the psychiatric problems, as
they believed the eye difficulty was a scheduled injury and there was no other injury "to
a nonscheduled portion of the anatomy to support the general disability." 211 Kan. at
543.

The Supreme Court reversed:

"It is firmly established in this jurisdiction that traumatic neurosis, following physical
injury and
shown to be directly traceable to the injury, is compensable under the Workmen's Compensation
Act.
([Jacobs, 196 Kan. 613; Hayes, 188 Kan. 179; Barr, 179
Kan. 617; and Morris, 144 Kan. 790.]) The rule
in this jurisdiction is in line with that followed generally. In this connection Vol. 1A Larson
Workmen's
Compensation Law, § 42.22, p. 622.162 has this to say:

'. . . [W]hen there has been a physical accident or trauma, and claimant's disability
is
increased or prolonged by traumatic neurosis, conversion hysteria, or hysterical paralysis, it is
now uniformly held that the full disability including the effects of the neurosis is compensable. . .
.'"
211 Kan. at 544.

The court in Rund v. Cessna Aircraft Co., 213 Kan. 812, 518 P.2d 518
(1974),
found that Mable Rund was apparently injured in a work-related accident. The
determination of her physical injury caused the court no difficulty. It was the alleged
aggravation of a psychosexual problem which lead to a 4-3 split on the court, with the
majority denying coverage based on that complaint. The majority stated:

"In [Hayes], the court was confronted with traumatic neurosis. There the
district court found the
claimant 100% totally and permanently disabled as a result of traumatic neurosis and that such
condition
was directly caused and was the result of the accident and injuries sustained by the
claimant. On appeal
the judgment of the trial court was affirmed on the ground that claimant's mental condition which
rendered
him totally disabled was directly traceable to his accidental injury which disabled
him. The claimant's
mental condition was described as a chronic anxiety reaction. In the opinion the court said:

'. . . Traumatic neurosis, following physical injury, long has been recognized as
being
compensable under workmen's compensation laws, and the rule is applicable to such injury
even though financial and other worries pay a part. . . . [Hayes, 188 Kan. at 184].'

"'Traumatic neurosis' is defined as 'A neurotic condition brought on by an injury.'
Trauma is
defined as 'An injury caused by mechanical violations, as a blow, twist, etc.' (2 Schmidt's
Attorneys'
Dictionary of Medicine, p. 900.7.)

"The testimony of Dr. Moe is that the claimant is unable to return to work at Cessna due
to inner
conflicts arising from guilt over sexual matters." 213 Kan. at 824-25.

The Rund court reviewed Jacobs and noted:

"In upholding the trial court this court recognized it had on numerous occasions held
traumatic neurosis
following physical injury, and shown to be directly traceable to such injury, to be compensable
under the
act. But the court said, this rule had no application where the district court found that although
claimant's
difficulty was the result of mental illness, he had suffered no physical injury.

"If the court had given full scope to the rule asserted by the appellee--that an employer
accepts
the employee with the pre-existing weaknesses in the employee at the time of her employment,
and that it
applies equally in psychiatric weakness as other physical weaknesses--then the court in
Jacobs should
have reversed the trial court. Certainly, the mental breakdown in the Jacobs case
was attributable to the
claimant's employment." 213 Kan. at 826.

The Rund court then stated: "Berger stands for the proposition
that traumatic
neurosis following physical injury, and shown to be directly traceable to such
injury, is
compensable under the Workmen's Compensation Act." 213 Kan. at 827.

The court then turned to Mrs. Rund's problems:

"To determine the point presently before the court we start with the proposition that
psychiatric
problems which cause disability of a workman, like any other compensable disability, must have
a direct
causal connection between the work being performed and the neurosis.

"Dr. Moe, the only psychiatrist to testify in the case, did not diagnose the claimant's
condition as
being that of traumatic neurosis or conversion hysteria, which the court
in Berger recognized as
synonymous terms. Dr. Moe's testimony was that the claimant demonstrated an 'obsessive
compulsive'
personality, and indicated a high degree of anxiety with a tendency toward hypochondriasis, and
immaturity to a surprising degree. The primary aspect of Dr. Moe's testimony is his opinion that
the
claimant had unconsciously resolved her inner guilt feelings over sexual matters by
simply remaining
away from the Cessna plant, and that the 'injury' claimed has enabled her to remain away. In this
respect,
the claimant, according to Dr. Moe has indicated a tendency to convert her inner tensions to
physical
complaints.

"The examiner in this case merely found that the claimant had 'emotional problems'. He
made no
finding that the claimant suffered traumatic neurosis or conversion hysteria. The district court
adopted as
its decision the award, findings and decision of the examiner, as approved by the director. Both
the
examiner and the district court found the claimant's emotional problems had been exacerbated by
the
accident. In other words that the claimant's emotional problems have become more
intense as a result of
the accident. There is no finding that the claimant's emotional problems
were directly traceable to the
work being performed by the claimant at the respondent's plant or to the
accident.

"This court has not previously held that 'emotional problems' based on mental conflicts
arising
from guilt over sexual matters at the place of employment are compensable under the Workmen's
Compensation Act.

"The significance of Jacobs is that if claimant's psychiatric problems do not
result from the nature
and requirements of the claimant's job, or are the result of external forces over which the
employer has no
control, then there is no causal connection between the claimant's mental disability and the work
being
performed.

"By analogy the claimant's emotional problems in the instant case, that of
inability to return to
Cessna due to her inner conflicts over sexual matters, do not arise from the nature and
requirements of
her job. Claimant's job was that of building pumps, deburring, working on a gear bench, some
lifting of
parts and tightening some nuts and bolts. Claimant, for pure personal reasons over which
management
had no control, chose to wear provocative clothing, spend excessive time with make-up and be
sexually
provocative with male employees. The testimony of Dr. Moe is uncontradicted that the
claimant's
'condition'--an inability to return to Cessna for work--is due to her unconscious guilt feelings
over sexual
matters, and that she resolves her problem merely by staying away from Cessna. Her emotional
problems, therefore, are not causally connected to the nature and requirements of her job, but to
her
anxieties and inner tensions created by her conduct on the one hand and her sense of morality on
the
other.

. . . .

"We conclude that there is no evidence presented by the record and no finding by the trial
court
that the claimant's 'emotional problems' were caused by the accident concerning which she
complains.
The evidence, at best is that the accident exacerbated her existing 'emotional problems'. This is
insufficient to meet the requirement that the claimant's 'emotional problems' be directly traceable
to the
accident." 213 Kan. at 827-29.

In Buck v. Beech Aircraft Corporation, 215 Kan. 157, 523 P.2d 697 (1974),
the
court cited general rules concerning when mental problems arising out of a
compensable work-related injury might also be compensable, but agreed with the trial
court that no connection between the physical and mental problems had been proven.
a mental problem which arose out of a worker's mental difficulties caused by a grisly
fatal accident to another worker. The court, citing the requirements that there be a
physical injury to the claimant, such as there was in Hayes, denied coverage.

Another step in our analytical journey is provided by Love v. McDonald's
Restaurant, 13 Kan. App. 2d 397, 771 P.2d 557, rev. denied 245 Kan. 784
(1989). In
Love, an employee with no previous history of mental problems apparently started
to
have traumatic neurosis because of a job related fall/injury. The claim on the neurosis
was denied under Ruse v. State, 10 Kan. App. 2d 508, 708 P. 2d 216 (1984), because
it failed to meet the fourth element of the Ruse test for traumatic neurosis coverage:
that there is a causal connection between the work claimant performed and the
neurosis. The Ruse court apparently drew this from its reading of Rund,
finding

"[I]f the claimant's psychiatric problems did not result from the nature and requirements of
the claimant's
job, or are the result of external forces over which the employer has no control, then there is no
causal
connection between the claimant's mental disability and the work being performed and,
consequently,
claimant cannot recover compensation. [Rund, 213 Kan. at 828.]" 10 Kan. App. 2d
at 509.

Love overruled Ruse on this fourth element:

"In Ruse, instead of recognizing two separate ways to establish a
compensable traumatic
neurosis claim depending on the presence or absence of physical injury, we established a
single and
more difficult test. Under Ruse, traumatic neurosis was compensable only
if the mental disability were
directly traceable to a work-related physical injury and could also be causally
connected to the conditions
and requirements of claimant's job.

"In Ruse, we established a test not justified by historic case law.

"Additionally, the reason for the requirement of a causal connection with the
work performed, as
articulated in Jacobs, no longer exists. Since the reason for that 'rule' no longer
exists, we hold the 'rule'
itself can no longer exist.

'In [Followill, 234 Kan. 791], a case not considered in
Ruse, the Supreme Court explicitly held
that traumatic neurosis is not compensable absent a physical injury
because mental injury
standing alone is not a 'personal injury' as defined by the Workers' Compensation Act. 234 Kan.
at 795-96.

"The court stated: 'We hold, in accordance with an unbroken line of worker's
compensation cases
in this state, that the obligation of an employer under K.S.A. 44-501 et seq. does not
extend to mental
disorders or injuries unless the mental problems stem from an actual physical
injury to the claimant.' 234
Kan. at 796. (Emphasis added.)

"As we read Followill, the possibility of a compensable traumatic neurosis
absent physical injury--as explored in Jacobs--simply no longer exists in Kansas. As
a result, we feel comfortable in returning to
the clear statement of the rule as enunciated in the earlier cases such as Morris and
Barr.

"We therefore hold that traumatic neurosis, following and directly traceable to a
work-related
physical injury, is compensable. As a result, the four-part test of Ruse is
overruled." Love, 13 Kan. App.
2d at 400-01.

Earlier in his opinion in Love, Judge Elliott noted:

"Syl. ¶ 7 of the Rund opinion stated:

'In a workmen's compensation case if the claimant's psychiatric problems do not result
from the
nature and requirements of the claimant's work, or are the result of external forces over which the
employer has no control, there is no causal connection between the claimant's mental disability
and the work being performed, and compensation cannot be awarded for the mental disability.'

"This syllabus paragraph is simply overbroad, if not inaccurate, in that it reflects the
portion of the
opinion which discusses Jacobs, in which no physical injury was
present, and describes but a portion--not
the whole--of the test then applicable for determining the compensability of traumatic neurosis
absent
physical injury." 13 Kan. App. 2d at 399.

Of course, Love dealt with a mental condition that did not
preexist the injury. But
whether there should be a broad reading of the question generated by the Rund
decision, whether there was a causal connection between the work performed and the
neurosis, was squarely presented and found to be no longer viable due to later (and
more specific and earlier) decisions. Review of Love by the Supreme Court was
requested and denied.

In Gleason v. Samaritan Home, 260 Kan. 970, 926 P.2d 1349 (1996), the
Supreme Court was presented with a claimant who, while working at a nursing home,
was struck by a patient.

The court found on the issue of psychological injuries:

"The crux of the Board's decision regarding psychological injury is its underlying conclusion
that the
claimant 'suffered [no] permanent functional impairment or any ongoing permanent work
disability as a
result of this incident.' (Emphasis added.) Traumatic neurosis is not compensable under
the Workers
Compensation Act absent a work-related physical injury. [Followill, 234 Kan. at
795-96.} Implicit in the
conclusion of the Board is that the neurosis or psychological disability is not directly traceable to
the
physical injury. As noted above, the Board's conclusion is supported by substantial competent
evidence."
260 Kan. at 977-78.

In other words, claimant had failed to establish a link between her physical injury
and her psychological injury, if there was one. The
Rund/Ruse/Love "causal
connection" question apparently was not implicated.

From our analysis, we draw the following conclusions:

1. Traumatic neurosis is covered under the Workers Compensation Act if it
results from a covered physical injury and meets the other requirements of the Act.

2. Traumatic neurosis caused by an emotional, nonphysical trauma on the job is
not covered in Kansas by the Workers Compensation Act.

3. As stated in Hayes, 188 Kan. at 184, under the Workers
Compensation Act,
traumatic neurosis is to be treated like any other health problem. If a subsequent
covered industrial accident aggravates, accelerates, or intensifies the disease or
affliction, the worker is not to be denied compensation just because it is a preexisting
condition.

The peculiar facts in Rund may well have justified a finding that the
claimant's
aggravated psycho-sexual problem was unrelated to any inability to work. However,
the attempt to equate dicta on that issue with an unstated reversal of the Hayes ruling
on the compensability of certain aggravated mental problems is wrong.